Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery

ABSTRACT Objective: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. Methods: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. Results: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. Conclusion: the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

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The Use of Fibrin-based Tissue Adhesives for Breast in Reconstructive and Plastic Surgery

Current Topics in Medicinal Chemistry ◽

10.2174/1568026619666191112101448 ◽

2020 ◽

Vol 19 (32) ◽

pp. 2985-2990 ◽

Cited By ~ 1

Author(s):

Kuo Chen ◽

Mikhail Y. Sinelnikov ◽

Vladimir N. Nikolenko ◽

Igor V. Reshetov ◽

Yu Cao ◽

...

Keyword(s):

Quality Of Life ◽

Postoperative Complications ◽

Plastic Surgery ◽

Fibrin Glue ◽

Reconstructive Surgery ◽

Tissue Adhesives ◽

Tissue Adhesion ◽

Advanced Technologies ◽

Breast Plastic Surgery

Background: Breast plastic surgery is a rapidly evolving field of medicine. The modern view of surgical trends reflects the desire to minimize complications and introduce advanced technologies. These always will be priorities for surgeons. Reconstructive surgery, a branch of plastic surgery focusing on restoration of lost functional and aesthetic component, seeks to enhance psychological rehabilitation and improves the quality of life, as well as aesthetic recovery. Objective: This review addresses the action of fibrin agents and their effect on the quality of surgical hemostasis. Discussion and Conclusion: The fundamental goals for the surgeon are to perform a minimally traumatic intervention and to prevent any form of complication. Achieving complete hemostasis is an intraoperative necessity. Timely prevention of bleeding and hemorrhagic phenomena can affect not only the outcome of the operation, but also the incidence of postoperative complications. Topics include the integrity of microvascular anastomoses, tissue adhesion, and the incidence of seromas and hematomas associated with fibrin glue usage. The literature on fibrin adhesives with respect to prevention of postoperative complications, and the effectiveness with active drainage also are analyzed.

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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Preceptors in Medical Residency Programs: Epidemiological Profile and Pedagogic Training

Revista Brasileira de Educação Médica ◽

10.1590/1981-5271v44.4-20200131.ing ◽

2020 ◽

Vol 44 (4) ◽

Author(s):

Aderval de Melo Carvalho Filho ◽

Almira Alves dos Santos ◽

Rozangela Maria de Almeida Fernandes Wyszomirska ◽

Isabella Costa Figueiredo Medeiros

Keyword(s):

Health Care Professionals ◽

The State ◽

Public Institution ◽

Medical Residency ◽

Residency Programs ◽

Service Training ◽

The Mean ◽

Definition Of ◽

Epidemiological Profile ◽

Mean Time

Abstract: Introduction: Medical Residency is a specialization course characterized as in-service training, considered in Brazil as the gold standard in the development of specialist physicians’ training. The medical residency preceptorship is an activity carried out by a specialist physician, responsible for monitoring resident physicians. However, there is neither a definition of the main requirements for such a preceptor, nor of his/her academic background to carry out the due teaching training, and it was possible to notice a relative lack of preparation regarding the pedagogical aspects. Methods: Descriptive study based on a quantitative approach, comprising 200 preceptors, of both genders, from medical residency programs in Maceió, state of Alagoas, Brazil. Results: The mean age was 43.31 ± 10.31 years, with a slight majority of female participants (52.5%). The mean time since graduation was 19.5 ± 10.58 years, and 83% of the participants had graduated in the state of Alagoas. Moreover, 78.5% said they had their Medical Residency certification, with an increased trend of public institution preceptors getting their degree at the stricto sensu level. The mean time of their completed postgraduate course was 12.63 ± 10.87 years and 7.07 ± 6.99 years being a preceptor. Only 19% mentioned they had some qualification for exercising the preceptorship, and 29.5% work as the teachers at the undergraduate level. The state of Alagoas has followed the expansion of the Residency programs, justifying the mean age found, similar to other studies. The majority of female participants can be associated with the feminization of health care professionals. The high percentage of preceptors with medical residency qualification is in accordance with Resolution n. 4/1978. We found experienced preceptors, but some authors differed. The low percentage of preceptors with qualification for exercising preceptorship indicates low interest and lack of available training. Conclusion: This study population is characterized as being young, and most are females. They have had long professional experience, and most have graduated in the state of Alagoas. There is a predominance of medical residency as their main qualification, and few of them have had training in the field. Finally, preceptors from public institutions have mostly got their degrees at the stricto sensu level.

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Quality of febrile neutropenia management in a regional cancer center emergency department.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.104 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 104-104

Author(s):

Priyanka Kapil ◽

Katherine Enright

Keyword(s):

Emergency Department ◽

Febrile Neutropenia ◽

Antibiotic Therapy ◽

Cancer Site ◽

Cancer Center ◽

Time To Initiation ◽

The Mean ◽

The Impact ◽

Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

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On the current enhancement at the edge of a crack in a lattice of resistors

Advances in Applied Probability ◽

10.1239/aap/1035228073 ◽

1998 ◽

Vol 30 (2) ◽

pp. 342-364 ◽

Cited By ~ 5

Author(s):

Howard M. Taylor ◽

Dennis E. Sweitzer

Keyword(s):

Random Walk ◽

Vertical Direction ◽

Potential Gradient ◽

Domain Of Attraction ◽

Lattice Points ◽

Fourier Methods ◽

The North ◽

The Mean ◽

Mean Time ◽

Cauchy Process

Consider a network whose nodes are the integer lattice points and whose arcs are fuses of 1Ω resistance. Remove a horizontal segment ofNadjacent vertical arcs, forming a ‘crack’ of lengthN. Subject the network to a uniform potential gradient ofvvolts per arc in the north-south (or vertical) direction and measure the current in one of the two vertical arcs at the ends of the crack. We write this current in the forme(N)v, and calle(N) thecurrent enhancement.We show that the enhancement grows at a rate that is the order of the square root of the crack length. Our method is to identify the enhancement with the mean time to exit an interval for a certain integer valued random walk, and then to use some of the well-known Fourier methods for studying random walk. Our random walk has no mean or higher moments and is in the domain of attraction of the Cauchy law. We provide a good approximation to the enhancement using the explicitly known mean time to exit an interval for a Cauchy process. Weak convergence arguments together with an estimate of a recurrence probability enable us to show that the current in an intact fuse, that is in the interior of a crack of lengthN, grows p roportionally withN/logN.

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Phocanema decipiens (Nematoda: Anisakinae): experimental infections in marine copepods

Canadian Journal of Zoology ◽

10.1139/z82-075 ◽

1982 ◽

Vol 60 (4) ◽

pp. 502-509 ◽

Cited By ~ 16

Author(s):

Gary McClelland

Keyword(s):

Gravid Female ◽

Mature Female ◽

Cyclopoid Copepod ◽

Calanoid Copepods ◽

North West ◽

The North ◽

The Family ◽

The Mean ◽

Mean Time ◽

Marine Copepods

Gravid female Phocanema decipiens were recovered from the stomachs of freshly killed harbour (Phoca vitulina) and grey seals (Halichoerus grypus). Ova dissected from the nematodes were incubated in seawater and the mean time to hatch varied from 8 days at 20 °C to 52 days at 5 °C. Posthatch survival of ensheathed larvae in seawater varied from 48 h at 20 °C to 140 days at 5 °C. Fifteen species of copepods collected from the North West Arm, Halifax, N.S., were exposed to freshly hatched larvae of P. decipiens. Exsheathed larvae of the parasite were subsequently detected in the haemocoel of 12 harpacticoid species including Danielsennia typica, Tisbe furcata, Ameira longipes, Enhydrosoma curticauda, and various undescribed species of the genera Halectinosoma, Tisbe, Alteutha, and Phyllothallestris and the family Diosaccidae. Phocanema decipiens also occurred in a cyclopoid copepod (Paracyclopina sp.) but calanoid copepods (Eurytemora sp. and Pseudocalanus sp.) did not become infected. The heaviest infections occurred in mature female copepods and prevalence and intensity of infection varied with host species. Adult male copepods and fifth copepodite females were lightly infected. Infected copepods survived for 3–7 days at 15 °C, 10–15 days at 10 °C, and 20–35 days at 5 °C. During the course of infection, larval P. decipiens grew an average of 60% and maximum of 130% in length but underwent little or no morphological change.

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Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

International Surgery Journal ◽

10.18203/2349-2902.isj20194430 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3715

Author(s):

K. R. Manoj Prabu ◽

Dhinesh Balaji ◽

Vishwanath M. Pai

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Cystic Duct ◽

Operating Time ◽

Cost Effective ◽

Safe Alternative ◽

Suture Ligation ◽

Medical College ◽

The Mean ◽

Mean Time

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

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HIV infection in pregnant women and its challenges for the prenatal care

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0784 ◽

2021 ◽

Vol 74 (suppl 4) ◽

Author(s):

Lidiane de Nazaré Mota Trindade ◽

Laura Maria Vidal Nogueira ◽

Ivaneide Leal Ataide Rodrigues ◽

Angela Maria Rodrigues Ferreira ◽

Gracileide Maia Corrêa ◽

...

Keyword(s):

Pregnant Women ◽

Educational Level ◽

Antiretroviral Treatment ◽

Analytical Study ◽

Viral Suppression ◽

Hiv Infections ◽

The Mean ◽

Epidemiological Profile ◽

Methods Analytical ◽

Type Of Delivery

ABSTRACT Objective: To analyze the epidemiological profile of HIV infections in pregnant women. Methods: Analytical study with a quantitative approach. Results: The HIV rate in pregnant women increased from 1.5/1000 babies born alive, in 2010, to 3.3/1000 in 2017. There was a significant association between the prenatal and the variables educational level (p<0.0001), occupation (p=0.0105), gestational age (p < 0.0001), and type of delivery (p < 0.0001). The mean rate of adherence to the antiretroviral treatment in the prenatal was 68.8% (DP = ± 3.7). Conclusion: The high rates of HIV detection in pregnant women suggest the need to intensify the health care to women during the prenatal, guaranteeing an integral care, early diagnoses, and enhancing the strategies to improve the adherence to the antiretroviral treatment, aiming to achieve the viral suppression of the mother by the time of childbirth, thus diminishing the risk of a vertical transmission.

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1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project

British Journal of Surgery ◽

10.1093/bjs/znab259.923 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Smith ◽

A Thompson ◽

P Stanier ◽

J Rooker ◽

I Lowdon

Keyword(s):

Final Report ◽

X Rays ◽

Improvement Project ◽

X Ray ◽

Constructive Feedback ◽

Wrist Trauma ◽

Specific Feedback ◽

The Mean ◽

Mean Time

Abstract Aim To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees. Method A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload. Results This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback. Conclusions This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.

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Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Neurosurgical FOCUS ◽

10.3171/2018.3.focus1850 ◽

2018 ◽

Vol 44 (6) ◽

pp. E15 ◽

Cited By ~ 4

Author(s):

Malte Mohme ◽

Friederike S. Fritzsche ◽

Klaus C. Mende ◽

Jakob Matschke ◽

Ulrike Löbel ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Course ◽

Case Series ◽

Diffuse Astrocytoma ◽

The Mean ◽

Mean Time ◽

Tectal Glioma ◽

Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

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